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Sandgren SS, Haycraft E, Arcelus J, Plateau CR. An intervention mapping adaptation framework to develop a self-help intervention for athletes with eating disorder symptoms. Int J Eat Disord 2023; 56:2022-2031. [PMID: 37564014 DOI: 10.1002/eat.24044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This research forum describes the use of the intervention mapping for adaptation (IMA) framework to develop and evaluate a novel intervention for athletes with mild eating disorder (ED) symptoms. METHODS The six IMA steps were followed. In step 1 (needs assessment), we conducted a systematic review of athlete ED interventions and held interviews/focus groups with athletes and sports professionals to inform intervention format and delivery. In step 2 (intervention search), needs assessment information guided the search for an evidence-based intervention suitable for adaptation to athletes. In steps 3 and 4 (intervention development), the identified intervention was adapted and feedback sought from athletes and sport professionals. In steps 5 and 6 (implementation and evaluation), a feasibility study was conducted with athletes (n = 35; females: n = 27; Mage = 27.1). RESULTS The review highlighted poor evidence for the acceptability and relative efficacy of existing interventions, which were all delivered face-to-face in groups. Interview/focus group data suggested a need for more accessible intervention formats (e.g., self-help). One non-athlete self-help intervention was determined suitable for adaptation to athletes, and adaptations were made. Initial feedback suggested the adapted intervention was relevant within sport settings. The feasibility study revealed that the intervention (MOPED-A: Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms) can be feasibly implemented, is acceptable to athletes and shows potential for reducing ED symptoms. DISCUSSION IMA is a useful framework for developing participant-centered and evidence-based interventions. The findings and approach taken provide a framework for other researchers and clinicians in developing similar interventions in the ED domain. PUBLIC SIGNIFICANCE The novel self-help intervention described in this article was developed using intervention mapping and provides promise as a tool for reducing eating disorder symptoms in athletes. We describe how adopting and systematically following a health intervention development approach, such as intervention mapping, can ensure that eating disorder interventions are participant-centered, contextually relevant, and evidence-based, which in turn could help to maximize their reach and effectiveness.
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Affiliation(s)
- Sebastian S Sandgren
- Department of Education and Sports Science, University of Stavanger, Stavanger, Norway
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jon Arcelus
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Carolyn R Plateau
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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2
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Rogal SS, Chinman MJ, DeMonte W, Gibson S, Hoyt-Trapp S, Klima GJ, Jonassaint NL, Liebschutz JM, Kraemer KL, Merlin J. Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis. Dig Dis Sci 2022; 67:5063-5078. [PMID: 35147816 DOI: 10.1007/s10620-022-07380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic pain is common among patients with cirrhosis and is challenging to treat. While promising, pain self-management (PSM) interventions have not been tailored to this population's needs. AIMS To design a PSM intervention for patients with cirrhosis. METHODS Semi-structured interviews with 17 patients with cirrhosis, 12 hepatologists, and 6 administrators from two medical centers were conducted to inform a rigorous, structured intervention mapping (IM) process. Qualitative content analysis was guided by social cognitive theory (SCT) and the Consolidated Framework for Implementation Research (CFIR) and incorporated into intervention development. A planning group met regularly throughout the intervention, to reach consensus about how to use data and theory to develop the intervention through IM. RESULTS Participants described barriers to PSM behaviors, including the absence of simple, evidence-based interventions for pain for patients with cirrhosis, inadequate provider knowledge, time, and training, and lack of champions, funding, and communication. Patients described high motivation to treat pain using behavioral methods including meditation, prayer, and exercise. The intervention was designed to address barriers to PSM behaviors for patients with cirrhosis, using behavior change methods that address knowledge, self-efficacy, and outcome expectations. The LEAP (Liver Education About Pain) intervention is a 12-week, modular intervention delivered by phone via individual and group sessions with a health coach. CONCLUSIONS People with cirrhosis, hepatologists, and administrators informed this theory-driven, tailored PSM intervention, which was designed to be implementable in the real world.
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Affiliation(s)
- Shari S Rogal
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA. .,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA.
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA.,RAND Corporation, Pittsburgh, PA, 15213, USA
| | - William DeMonte
- Virginia Mason Franciscan Health, Bonney Lake, WA, 98391, USA
| | - Sandra Gibson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA
| | | | - Gloria J Klima
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA
| | - Naudia L Jonassaint
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jane M Liebschutz
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Kevin L Kraemer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jessica Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Uebelacker LA, Cherenack EM, Busch A, Baker JV, Pinkston M, Gleason N, Madden S, Caviness CM, Stein MD. Pharmacologic and Non-Pharmacologic Treatments for Chronic Pain Used by Patients with Pain, HIV, and Depression. AIDS Behav 2022; 26:864-873. [PMID: 34468967 PMCID: PMC9125741 DOI: 10.1007/s10461-021-03447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/29/2022]
Abstract
The objective of this study was to understand pain treatment utilization, perceived efficacy, and differences in utilization by gender, clinic site, chronicity of pain, pain severity, and depression severity among people living with HIV (PLWH), chronic pain, and elevated depression symptoms. Participants included 187 PLWH at three HIV clinics in the U.S. Overall, 85% of participants reported taking a pain medication. One quarter (25%) reported non-pharmacological professional treatments for pain (e.g., massage, physical therapy), 60% reported mind-body treatments, including exercise, meditation, and yoga, and 62% reported other non-pharmacological self-administered treatments (e.g., heat/cold). Most pain treatments were considered "slightly helpful" or "moderately helpful." Non-pharmacological self-administered treatments were more commonly used among women than men and among individuals with constant vs. intermittent pain. Further research is needed to evaluate the efficacy of the preferred analgesic modalities of PLWH.
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Affiliation(s)
- Lisa A Uebelacker
- Alpert Medical School of Brown University, Providence, RI, USA.
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA.
| | - Emily M Cherenack
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Andrew Busch
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jason V Baker
- Hennepin Healthcare, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Megan Pinkston
- Alpert Medical School of Brown University, Providence, RI, USA
- Miriam Hospital, Providence, RI, USA
| | | | | | - Celeste M Caviness
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Michael D Stein
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Boston University, Boston, MA, USA
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4
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Bendig E, Bauereiß N, Buntrock C, Habibović M, Ebert DD, Baumeister H. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - An internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv 2021; 24:100375. [PMID: 33732627 PMCID: PMC7941156 DOI: 10.1016/j.invent.2021.100375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite the high prevalence of comorbid depression in people living with coronary artery disease (CAD), uptake of psychological treatment is generally low. This study was designed to investigate the feasibility of an internet-based cognitive-behavioral (iCBT) depression intervention for people with CAD and depressive symptoms. METHODS People with CAD and depressive symptoms (PHQ-9 ≥ 5) were randomly assigned to the eight modules comprising iCBT (N = 18), or waitlist-control (N = 16). Measures were taken at baseline (t1) and at post-treatment (eight weeks after randomization, t2). Feasibility-related outcomes were recruitment strategy, study attrition, intervention dropout, satisfaction, negative effects as well as the potential of the intervention to affect likely outcomes in a future full-scale trial (depression, anxiety, quality of life, fear of progression). Data analyses were based on intention-to-treat principles. Linear regression models were used to detect between group differences. Linear Mixed Models were used to model potential changes over time. RESULTS This trial was terminated prior to a-priori defined sample size has been reached given low recruitment success as well as high intervention dropout (88%) and study attrition (23%). On average, participants in the intervention group completed M = 2.78 (SD = 3.23) modules. Participants in the waitlist control group barely started one module (M = 0.82, SD = 1.81). The satisfaction with the intervention was low (M = 20.6, SD = 0.88). Participants reported no negative effects attributed to the iCBT. Differences between groups with regard to depression, anxiety, fear of progression and quality of life remained non-significant (p > 0.05). CONCLUSION This trial failed to recruit a sufficient number of participants. Future work should explore potential pitfalls with regards to the reach and persuasiveness of internet interventions for people living with CAD. The study gives important indications for future studies with regard to the need for new ideas to reach and treat people with CAD and depression.
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Key Words
- APOI, Attitudes towards Psychological Online Interventions Questionnaire
- AQoL-8D, Inventory for the Assessment of Quality of Life
- CAD, Coronary artery disease
- CBT, Cognitive Behavioral Therapy
- CG, waitlist control group
- CSQ, Client Satisfaction Questionnaire
- Cognitive behavioral therapy
- Coronary artery disease
- Depression
- EG, intervention group
- FOP-Q-SF, Fear of Progression Questionnaire
- GAD-7, Generalized Anxiety Disorder 7-item Scale
- HADS, Hospital Anxiety and Depression Scale
- INEP, Inventory for the assessment of negative effects of psychotherapy
- ITT, intention-to-treat
- Internet and mobile-based intervention
- PHQ-9, Patient Health Questionnaire
- Psychological intervention
- SMS, short message service
- WIDeCAD, Web- and mobile-based Intervention for DEpression in people with CAD
- iCBT, internet-based cognitive behavioral therapy
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
| | - David Daniel Ebert
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, Vrije University Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
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Palfai TP, Saitz R, Kratzer MPL, Taylor JL, Otis JD, Bernstein JA. An integrated videoconferencing intervention for chronic pain and heavy drinking among patients in HIV-care: a proof-of-concept study. AIDS Care 2020; 32:1133-1140. [PMID: 32524827 DOI: 10.1080/09540121.2020.1776825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chronic pain and heavy drinking are common comorbid conditions among people living with HIV/AIDS (PLWHA). An integrated approach to address these co-occurring conditions in a manner that facilitates treatment utilization would represent an important advance in HIV-care. This study examined the acceptability and feasibility of a tailored, videoconferencing intervention to reduce chronic pain and heavy drinking among PLWHA. Participants in HIV-care (n = 8) completed baseline assessments and an in-person intervention session followed by 6 videoconferencing sessions. Acceptability and feasibility were assessed with patient satisfaction ratings and interview responses 8 weeks following baseline along with videoconferencing use during the intervention period. Treatment satisfaction and comprehensibility ratings were high and supported by interview responses indicating the value of the intervention content, treatment alliance, and format. All participants successfully enabled videoconferencing on their own smartphones and completed a median number of 4.5 (out of 6) video-sessions. Changes in heavy drinking and pain provided additional support for the potential utility of this approach. Results suggest that this videoconferencing intervention is an acceptable and feasible method of addressing chronic pain and heavy drinking among PLWHA. Findings provide the basis for future work to examine the efficacy of this approach in a Stage 1b trial.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.,Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jessica L Taylor
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Judith A Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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6
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Sweeney L, Moss-Morris R, Czuber-Dochan W, Belotti L, Kabeli Z, Norton C. 'It's about willpower in the end. You've got to keep going': a qualitative study exploring the experience of pain in inflammatory bowel disease. Br J Pain 2019; 13:201-213. [PMID: 31656626 PMCID: PMC6791049 DOI: 10.1177/2049463719844539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pain is a widely experienced symptom of inflammatory bowel disease (IBD), which has significant psychological and functional impacts on patients. Understanding the aetiology and management of chronic pain is a poorly understood area of IBD research. This qualitative study aimed to explore the experiences of individuals with IBD and pain, the pain management strategies they use and any needs for future pain management interventions. METHODS In all, 14 individuals with IBD were purposively recruited and interviewed (face-to-face or telephone) using a topic guide. Interviews were transcribed and analysed using inductive thematic analysis. RESULTS Themes identified were 'vicious cycles', 'findings solutions' and 'attitudes'. The experience and impact of pain were rarely viewed in isolation, but rather within the context of a cycle of IBD symptoms. Other 'vicious cycles' identified included anxiety, avoidance and inactivity, and poor understanding and communication. Pain management included short- and long-term strategies. Searching for a solution for pain had an emotional impact on individuals. There were contrasting attitudes from participants, including defeat, tolerance and acceptance. CONCLUSION This study provides an understanding of the experience of pain in IBD. The interaction of pain with accompanying IBD symptoms has an emotional and physical impact on individuals, and creates a barrier to adequate assessment, understanding and treatment of pain. Patients rely on their own experiences, and a trial and error approach to apply helpful strategies. Adjuvant behavioural therapies may be beneficial for patients experiencing pain and psychological distress, and to facilitate self-management.
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Affiliation(s)
- Louise Sweeney
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | | | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Laure Belotti
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Zoe Kabeli
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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7
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Palfai TP, Taylor JL, Saitz R, Kratzer MPL, Otis JD, Bernstein JA. Development of a tailored, telehealth intervention to address chronic pain and heavy drinking among people with HIV infection: integrating perspectives of patients in HIV care. Addict Sci Clin Pract 2019; 14:35. [PMID: 31464645 PMCID: PMC6714455 DOI: 10.1186/s13722-019-0165-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/23/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic pain and heavy drinking commonly co-occur and can influence the course of HIV. There have been no interventions designed to address both of these conditions among people living with HIV (PLWH), and none that have used telehealth methods. The purpose of this study was to better understand pain symptoms, patterns of alcohol use, treatment experiences, and technology use among PLWH in order to tailor a telehealth intervention that addresses these conditions. SUBJECTS Ten participants with moderate or greater chronic pain and heavy drinking were recruited from a cohort of patients engaged in HIV-care (Boston Alcohol Research Collaborative on HIV/AIDS Cohort) and from an integrated HIV/primary care clinic at a large urban hospital. METHODS One-on-one interviews were conducted with participants to understand experiences and treatment of HIV, chronic pain, and alcohol use. Participants' perceptions of the influence of alcohol on HIV and chronic pain were explored as was motivation to change drinking. Technology use and treatment preferences were examined in the final section of the interview. Interviews were recorded, transcribed and uploaded into NVivo® v12 software for analysis. A codebook was developed based on interviews followed by thematic analysis in which specific meanings were assigned to codes. Interviews were supplemented with Likert-response items to evaluate components of the proposed intervention. RESULTS A number of themes were identified that had implications for intervention tailoring including: resilience in coping with HIV; autonomy in health care decision-making; coping with pain, stress, and emotion; understanding treatment rationale; depression and social withdrawal; motives to drink and refrain from drinking; technology use and capacity; and preference for intervention structure and style. Ratings of intervention components indicated that participants viewed each of the proposed intervention content areas as "helpful" to "very helpful". Videoconferencing was viewed as an acceptable modality for intervention delivery. CONCLUSIONS Results helped specify treatment targets and provided information about how to enhance intervention delivery. The interviews supported the view that videoconferencing is an acceptable telehealth method of addressing chronic pain and heavy drinking among PLWH.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA.
| | - Jessica L Taylor
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA, USA
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA, USA.,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA
| | - Judith A Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, USA
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Merlin JS, Westfall AO, Long D, Davies S, Saag M, Demonte W, Young S, Kerns RD, Bair MJ, Kertesz S, Turan JM, Kilgore M, Clay OJ, Starrels J, Pekmezi D, Johnson MO. A Randomized Pilot Trial of a Novel Behavioral Intervention for Chronic Pain Tailored to Individuals with HIV. AIDS Behav 2018; 22:2733-2742. [PMID: 29340913 PMCID: PMC6047927 DOI: 10.1007/s10461-018-2028-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Chronic pain is an important and understudied comorbidity in people living with HIV (PLWH). We conducted a pilot trial of Skills TO Manage Pain (STOMP), an innovative social cognitive theory-based pain self-management intervention tailored to PLWH, to assess feasibility, acceptability, and preliminary efficacy. Eligibility criteria included being HIV+, ≥ moderate pain for ≥ 3 months and a score of ≥ 4 on the three-item PEG pain severity and interference scale. Participants were randomized in a 1:1 fashion to STOMP or a usual care comparison. Among 22 participants randomized to STOMP, median session attendance was 9/12 (75%). Of 19 STOMP participants surveyed, 13 reported being "much better" overall since beginning treatment. Brief pain inventory-total scores decreased by 2 points in the intervention group and 0.9 in the control group (p = 0.11). STOMP is feasible, acceptable, and shows preliminary evidence of efficacy and promise for a full-scale trial.
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Affiliation(s)
- Jessica S Merlin
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA.
| | - Andrew O Westfall
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Davies
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Demonte
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Young
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Social Work, Binghamton University, Binghamton, NY, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Indianapolis, USA
- Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Stefan Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivio J Clay
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna Starrels
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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9
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Merlin JS, Young SR, Johnson MO, Saag M, Demonte W, Kerns R, Bair MJ, Kertesz S, Turan JM, Kilgore M, Clay OJ, Pekmezi D, Davies S. Intervention Mapping to develop a Social Cognitive Theory-based intervention for chronic pain tailored to individuals with HIV. Contemp Clin Trials Commun 2018; 10:9-16. [PMID: 29696153 PMCID: PMC5898474 DOI: 10.1016/j.conctc.2018.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 12/23/2022] Open
Abstract
Chronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.
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Affiliation(s)
- Jessica S. Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States
- Corresponding author. 230 McKee Place Suite 600, Pittsburgh, PA, 15213, United States.
| | - Sarah R. Young
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mallory O. Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Michael Saag
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - William Demonte
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, New Haven, CT, United States
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, United States
| | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, United States
- Department of Medicine, Division of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
| | - Stefan Kertesz
- Birmingham VA Medical Center, Birmingham, AL, United States
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Meredith Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Olivio J. Clay
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Susan Davies
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Merlin JS, Westfall AO, Johnson MO, Kerns RD, Bair MJ, Kertesz S, Turan JM, Clay OJ, Starrels JL, Kilgore M. Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH). J Med Econ 2018; 21:122-126. [PMID: 28880698 PMCID: PMC6028014 DOI: 10.1080/13696998.2017.1377719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP). OBJECTIVES Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP's preliminary efficacy, but also its cost-effectiveness. RESEARCH DESIGN AND SUBJECTS The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities. RESULTS Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225. CONCLUSIONS STOMP's cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.
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Affiliation(s)
- Jessica S Merlin
- a Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA
- b Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Andrew O Westfall
- a Division of Infectious Diseases , University of Alabama at Birmingham , Birmingham , AL , USA
- c Department of Biostatistics, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mallory O Johnson
- d Department of Medicine , University of California-San Francisco , San Francisco , CA , USA
| | - Robert D Kerns
- e Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System , West Haven , CT , USA
- f Departments of Psychiatry, Neurology and Psychology , Yale University , New Haven , CT , USA
| | - Matthew J Bair
- g Veterans Affairs Health Services Research & Development Center for Health Information and Communication , Indianapolis , IN , USA
- h Department of Medicine, Division of General Internal Medicine , Indiana University School of Medicine , Indianapolis , IN USA
- i Regenstrief Institute , Indianapolis , IN , USA
| | - Stefan Kertesz
- j Birmingham VA Medical Center , Birmingham , AL , USA
- k Division of Preventive Medicine, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Janet M Turan
- l Department of Health Care Organization and Policy, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Olivio J Clay
- m Department of Psychology, College of Arts and Sciences , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Joanna L Starrels
- n Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA
| | - Meredith Kilgore
- l Department of Health Care Organization and Policy, School of Public Health , University of Alabama at Birmingham , Birmingham , AL , USA
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